title: Mycobacterial infections in the era of modern biologic agents.
abstract: Patients with rheumatologic disease are at increased risk for mycobacterial infections because of both immunocompromising therapy and preexisting lung damage from the disease itself. Tuberculosis is uncommon in the United States; however, it is relatively more prevalent in immigrants, minorities, elderly, persons with acquired immune deficiency syndrome and among healthcare workers. In the United States, the nontuberculous mycobacteria (NTM) are now more prevalent than tuberculosis. Although initially noted in men with chronic obstructive pulmonary disease, recent observations indicate increasing numbers of NTM cases in slender white women. Because of the often atypical presentation of NTM lung disease, diagnosis is commonly delayed. Because there is solid evidence that tumor necrosis factor-alpha-modifying agents are associated with serious NTM disease, it is important that specific screening tests (eg, chest x-ray, computed tomographic lung scans, sputum cultures or referral to pulmonary or infectious disease specialists) be used before initiating anti-tumor necrosis factor therapy.
authors.affiliation: Department of Medicine, National Jewish Health, Denver, Colorado 80206, USA. isemanm@njhealth.org
authors.forename: Michael D
authors.initials: MD
authors.lastname: Iseman
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents / Q000627:therapeutic use; D000068800:Etanercept; D005820:Genetic Testing; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D000069285:Infliximab; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy; D008171:Lung Diseases / Q000453:epidemiology* / Q000382:microbiology*; D009164:Mycobacterium Infections / Q000453:epidemiology*; D015995:Prevalence; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012216:Rheumatic Diseases / Q000188:drug therapy*; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept